1999 Volume 6 Issue 1 Pages 47-51
Postresuscitative consciousness disturbance was ameliorated by a two-step procedure of spinal cord stimulation. A 30-yr-old man fell into unconsciousness and apnea, and was transported to our ICU undergoing cardiopulmonary resuscitation (CPR). On admission, he was in coma with predominant theta waves on electroencephalogram (EEG) and with prolonged latencies on auditory brainstem response (ABR), but there were no abnormal findings on the brain CT.
We commenced therapy for cerebral protection, including mild hypothermia (35°C), reduction of intracranial pressure, and hyperbaric oxygenation for one week. On the 12th day, eye opening to pain and normal ABR findings were observed without improvement of EEG findings. On the 20th day, atrophic changes were observed on brain CT over the entire cerebrum, especially in the left temporal lobe.
A two-step procedure of spinal cord stimulation was carried out to help improve the patient's level of consciousness. First, a transcutaneous magnetic stimulation was non-invasively achieved using a Magstim 200(R) (the MAGSTIM company Ltd. U. K.) from the 29th to the 64th day. Spontaneous opening of the eyes appeared after the 2nd stimulation, and verbal sounds and swallowing after the 5th stimulation. The next step involved the surgical implantation of epidural electrodes for spinal cord stimulation at the C3-C6 levels, followed by the start of electric stimulation from the 138th day. One month later, alpha waves on EEG and verbal sounds increased. The patient has been undergoing rehabilitation since then.
A two-step procedure of spinal cord stimulation may be useful in curing disturbance of consciousness after CPR.
